Provider Demographics
NPI:1114048931
Name:CAMPBELL, BRENDA ANN (DC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 WAPELLO ST S
Mailing Address - Street 2:
Mailing Address - City:MEDIAPOLIS
Mailing Address - State:IA
Mailing Address - Zip Code:52637-9422
Mailing Address - Country:US
Mailing Address - Phone:319-394-9730
Mailing Address - Fax:319-394-9731
Practice Address - Street 1:219 WAPELLO ST S
Practice Address - Street 2:
Practice Address - City:MEDIAPOLIS
Practice Address - State:IA
Practice Address - Zip Code:52637-9422
Practice Address - Country:US
Practice Address - Phone:319-394-9730
Practice Address - Fax:319-394-9731
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07230OtherBCBS
IA07230OtherBCBS